Module 10- Valvular Heart Disease & Hemostasis Flashcards by Megan Manasco

Frank starling mechanism aka

Hertometric autoregulation

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Obstruction in HOCM is worsened by

Increase contractility

Decreased preload

Decreased afterload

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On arterial waveform with HOCM may see

Biferiens pulse (bifid)

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Symptoms of AI are severe when

Regurgitant volume is >60% of SV

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Manifestations of which valve disorder

Diastolic murmur at left sternal border
Wide pulse pressure
Decreased diastolic pressure
bounding peripheral pulses

Chronic AI

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Chronic MR due to

Rheumatic fever

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Acute MR due do

Myocardial ischemia or infarction

Chordae tendonae rupture

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Severe MR symptoms occur at what %

> 60% regurgitant volume

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Which valve disorder is afib not tolerated at all

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Severe AS when AVA is

0.8-1cm

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Critical AS when AVA

0.5-0.8cm2

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Classic symptoms of AS

Syncope

Angina

Dyspnea

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Spinal and epidural are contraindicated in what valve lesion

Severe AS

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Mitral stenosis is usually caused by

Delayed complication of rheumatic fever

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Mitral stenosis is when MVA

Less than 2 cm2

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Which valve disorder can lead to enlarged LA causing pressure on left RLN = hoarseness

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Cardiac surgery patient is heparinized but ACT does not increase above 400. What are 2 causes

Antithrombin III deficiency

NTG reduces heparin efficacy

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If patient has antithrombin III deficiency and isn’t responsive to heparin what should you do

2 units FFP

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Normothermia pump flow during CBP is

50-70 ml/kg/min

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What vessels can be compressed by mediastinoscope

Inominate artery- lose RUE flow

Right carotid

Right subclavian

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Where do you place cuff and Aline for mediastinoscopy. Why

Cuff LUE- monitor for hemorrhage

Aline- RUE monitor for inominate occlusion

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What is stump pressure

Backpressure from collateral flow through circle of willis via the contralateral carotid artery and vertebrobasilar system

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During CEA where should PACO2 be kept

35-45mmHg

Avoid hypocapnia induced vasoconstriction

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Overall result of aortic cross clamping in hemodynamics

Reduction in LV EF and CO

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In anterior spinal artery syndrome what is lost? What sensations remain

Lose motor function and pinprick Keep proprioception and vibration

Debakey I dissection

Originates in ascending aorta and involves ascending aorta, Arctic arch, and lengths of thoracic and abdominal aorta

Debakey II dissection

Confined to ascending aorta

Debakey III dissection

Confined to descending thoracic aorta

Stanford Type A dissection

Ascending aorta involvement

Stanford Type B dissection

Ascending aorta not involved

Define hypertensive crisis

BP > 180/120

In hypertensive emergency how fast/slow should BP be decreased Drug of choice

25% within 30-60 minutes Nipride or Cleviprex

What is the leading cause of postoperative hospital admission

Inadequate pain relief

Electrocautery interferes with what park of a pacemaker

The sensing mode

What electrolyte and acid-base imbalances can lead to loss of pacing

Acute hypokalemia Acute hypercalcemia Respiratory alkalosis

Platelets release what substances that play a key role in initial vasoconstriction

Thromboxane A2 ADP

Endothelium that is damaged releases key procoagulants. What are 2

Tissue factor (III) vWF (VIII)

What clotting factors are not produced by the liver

IV calcium VIII vWF III Tissue factor

Function of thromboxane A2

Amplify the signal and action of more potent platelet agonists

What clotting factors are Vitamin K dependent

II VII IX X

Factor VIII is necessary for

Platelet adhesion to collagen vWF

Function of GpIIb/IIIa

Binds fibrinogen and promotes platelet aggregation

Protein C function

Vitamin K dependent ANTICOAGULANT Promotes fibrinolysis

Aplastic anemia is due to what

Lack of functioning bone marrow Chemo

Megaloblastic anemia is cause by what

Lack of vitamin B12 or folic acid Large immature erythrocytes- RBCs fail to mature

What kind of RNC seen in iron deficiency anemia

Hypochromic, microcytic RBC

What will be seen in a patient with glucose-6-phosphate dehydrogenase deficiency

Hemolytic anemia

What 2 drugs would you avoid in glucose-6-phosphate dehydrogenase deficiency

Nipride and prilocaine due to Increased risk of cyanide toxicity ASA, PCN, streptomycin, sulfonamides, quinidine, and methylene blue

What disease results from impaired synthesis of alpha-globin or beta-globin strands

Thalassemia

What disease results form a mutation on both beta-globin strands

Sickle cell anemia

What factors are in cryoprecipitate

VIII:C VIII:vWF XIII Fibrinogen

What drug can increase factor VIII:vWF

Desmopressin DDAVP

What clotting factor is hemophilia A

VIII:C Give factor VIII concentrate

ACT and PTT measure which pathway

Intrinsic

PT monitors which pathway

Extrinsic

What does bleeding time measure

Quantity and quality of platelets

Spontaneous bleeding occurs when platelet count falls below what

20,000

How long should 3 Gs (herbals) be discontinued before surgery

2 weeks

Herbals that inhibit platelet aggregation

Garlic Fishoids DHEA

TEG interpretation R

Reaction time Intrinsic pathway

TEG interpretation K

Clot formation time Thrombin formation or generation of fibrin from fibrinogen

TEG interpretation MA

Strength of clot Platelet number and function

TEG interpretation (MA+ X)/MA

Measure of fibrinolysis

3 steps of primary hemostasis

Adhesion Activation Aggregation

What activates platelets

Activated factor II (thrombin)

What aggregates platelets

Factor I - fibrinogen

Extrinsic pathway

Factor III Factor VII For 37 cents you can buy the extrinsic pathway

Intrinsic pathway

Factor XII Factor XI Factor IX Factor VIII If you cannot buy the intrinsic path for $12 you can buy it for $11.98

Final common pathway

``` Factor V Factor X Factor I Factor II Factor XIII ``` Final common pathway can be purchased at the 5 and dime (10) for $1 or $2 on the 13th

Hemophilia B is factor what deficiency

Factor IX

Heparin increases the activity of antithrombin III which binds what clotting factors

``` II IX X XI XII ```

Coumadin MOA

Competitively inhibits vitamin K synthesis of Vitamin K dependent clotting factors (II, VII, IX, X, protein C and S)

Aprotinin MOA

Inhibits breakdown of fibrin by inhibiting plasmin

What electrolytes are in Normosol R

``` Sodium Potassium Magnesium Acetate Gluconate ```

Max dosage of Hetastarch and Dextan 40

20 ml/kg/day

Most frequent infection associated with blood transfusion

Hepatitis C

EBV female

65 ml/kg

EBV male

75ml/kg

EBV preterm neonate

90-100ml/kg

EBV term neonate

80-90 ml/kg

EBV 3 mo - 3 yrs

75-80 ml/kg

EBV child

65-70 ml/kg

MABL formula

MABL = EBV X (initial hct - acceptable hct)/initial Hct

Hct of PRBC

50-80%

What blood product is ABO compatibility not mandatory

Platelets

Module 10- Valvular Heart Disease & Hemostasis Flashcards

(85 cards)